comparison of two fasciocutaneous flaps in the reconstruction of defects of the weight-bearing heel

To compare the indications, ease of elevation, operative time, complications and durability of two fasciocutaneous flaps i.e. sensate medial plantar artery flap and distally based sural artery neurocutaneous flap, used for the coverage of weight bearing heel in young ambulant adults. Design: A comparative study. Place and duration of study: CMH Rawalpindi and PIMS Islamabad during the period from May 1995 to April 2002. Patients and All the patients fulfilling the inclusion criteria discussed later in the text were divided into two groups. Twenty patients underwent a medial plantar artery flap [MPAF] while 30 had their defects reconstructed by a sural artery neurocutaneous flap [SANF]. The mode of presentation was noted in each case with a special note of the etiology. Postoperatively the patients were followed-up to evaluate any early or long-term complications. The MPAF group consisted of 20 patients including 16 males and 4 females with a mean age of 28 years [range 22 to 37 years]. The SANF group consisted of 30 patients including 29 males and only one female with a mean age of 30 years [range 23-38 years]. In both groups a majority of patients presented with a history of road traffic accidents and was managed by delayed primary procedure. The duration of the operation was considerably less in SANF coverage i.e., 50-100 minutes compared to 120-190 minutes for the MPAF. Flap survival was 100% in both the groups. The postoperative complications were more in patients who underwent SANF. Complete weight-bearing was started at 6 weeks in medial plantar artery flap whereas the same started 6-8 weeks in sural artery neurocutaneous flap. Average time for return to work was 8 weeks in medial plantar artery flap but it was double [12 weeks] in sural artery neurocutaneous flap. The medial plantar artery flap provides sensate and the same quality skin cover to the weight-bearing heel as compared to the distally based sural artery neurocutaneous artery flap. The medial plantar artery flap procedure is longer to perform but allows early weight-bearing with less complications than the distally based sural artery neurocutaneous flap

Reconstruction of lip defects with the Karapandzic technique

To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment. Design: A descriptive study. Place and Duration of Study: CMH Rawalpindi from January 1994 to January 2002. Subjects and Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstructon with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed. A total of 37 patients were included in the study. Thirteen [35%] patients were outdoor cases while 24 [65%] were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21[57%] patients and under local anesthesia in 16 [43%] cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 [11%] patients. Wound infection and wound dehiscence was observed in 03 [08%] patients. Sensations were completely intact in 29 [78%] patients and aesthetically 28 [76%] patients gave normal look at the end of two years [2Y]. Twenty-seven [74%] patients had no change in speech and only one [3%] patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 [95%] patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years. The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occuring in early postoperative stage, shows gradual improvement on long-term follow-up